Kaitlin "She's a person, not just a high risk."
Kaitlin is a doula. I've known her for some time now, and have helped her through the beginning of her doula journey. During this time, I had met Ryan, her first son. He is a rambunctious, loving, and funny kid, whose life started earth side at 27 weeks gestation via emergency cesarean section, five years ago. A lot of Ryan's pregnancy and birth, plays into this story, the way she was treated, and the doctors fears.
Kaitlin has had type 1 diabetes for 17 years now. This condition automatically puts her into the high risk category. On top of that, Kaitlin also has a kidney condition, IgA Nephropathy, which is another check box in the high risk category. Kaitlin during her pregnancy with Ryan also became eclamptic. While many of us probably know someone who has had pre-eclampsia toward the end of their pregnancy, Kaitlin's case developed, quickly, early, and turned into full blown eclampsia. She doesn't remember a lot of Ryan's birth, due to seizing through it. Again, this is another checkbox, for high risk.
When Kaitlin became pregnant this time, she also decided she'd like to attempt a vaginal birth after cesarean, another check in the risk category, for many providers. Originally, Kaitlin had chosen a different doula, a peer that she has connected with. She had chosen a new provider and a new hospital this time around. She wanted a different experience. I was hopeful for her that this time would be different.
In February I answered my phone and there was a crying Kaitlin on the other side. She had told me that at an appointment, she had refused a cervical check (she wasn't even midway through her pregnancy) and a few days later received a letter from her provider dropping her care. I was shocked and flabbergasted for her. She was devastated and now not sure what to do.
During her tears she asked me to please be her doula. That she realized she needed a different type of expertise as this was going to be much more of a fight than we had once hoped. I of course agreed and began to brainstorm where we would head next.
Progressive Women's Health at St. Francis came to mind. In particular Dr. Steadman. She is cautious, wildly intelligent, and insanely supportive. While she would never let a client put themselves or their baby in danger, I knew with all of the right supports in place, she just might be the one to let Kaitlin try for a VBAC.
Kaitlin transferred her care there in March. On top of seeing her provider, she would also have appointments with maternal fetal medicine, endocrinology, nephrology, dieticians, and two times per week non-stress tests for baby. She was exhausted from the constant appointments, but was focused on her end goal.
Every week, felt like a win. We had mini celebrations when she passed her gestational week that Ryan was born, and one every week after that. Kaitlin asked that I attend an appointment with her, with MFM. She knew this would be the appointment that they would want to schedule her an induction. She was right. As we stood in the room with the ultrasound tech and the doctor, she began discussing when she wanted the baby out by. She started with repeat section talk, and Kaitlin reminded her she was having a VBAC. The doctor continued to give Kaitlin reasons why, and in a very respectful way, I challenged her reasons with statistics. Kaitlin was having ZERO complications so far, and I was fighting for scheduling as far out as possible, or until complications started. "She's a person, not just a high risk," I noted. We escaped that appointment without an induction date that time.
I then went with Kaitlin to the following dietician appointment. It's required to see a dietician when you have any diabetes during pregnancy usually. I watched Kaitlin in awe as she educated the dietician and as the dietician took notes. If you are reading this, and have diabetes or know someone who has diabetes type 1, type 2, or gestational diabetes, and is pregnant or planning to get pregnant, Kaitlin (after her recovery of course!) is someone to have in your corner. The entire pregnancy, including during her labor, I heard doctor after doctor compliment her on keeping everything in control, on the knowledge she had, including allowing for her to manage her own care, including staying on and adjusting her pump as she saw fit. During her labor, her care would have to follow hospital protocol, but the endocrinologist that visited, explained to her nurses and OB's to please allow for Kaitlin to get back to her own diabetes care, when she saw fit. She even corrected a doctor when they gave the wrong information. She is a wealth of knowledge ya'll!
Things however, would eventually turn out of our favor. On Monday July 2nd, at 35 weeks gestation, it was 4:40pm and Kaitlin called me. They were admitting her for a 24 hour urine culture. She was having signs of pre-eclampsia, with her history and other risk factors, they weren't going to take the normal wait and see approach. Kaitlin checked into the hospital at 8pm that night.
We started texting early the next morning, and at 8:40am she told me that they had decided on an induction that day. They had actually been pushing for a repeat cesarean section, but Kaitlin insisted on having her chance at a trial of labor.
When I arrived at the hospital, Kaitlin had been delaying the the start of the induction. This wasn't what she wanted, and she was going to have some control over it. Her cervix was finger tip dilated, and 20% effaced. They decided to start with a cook catheter first. This meant they would have to manually dilate her a little bit to get the tube through the cervix. It was a wildly uncomfortable procedure. Women attempting a VBAC, cannot have the cervical ripeners that would usually be used prior to starting a balloon or pitocin.
Surprisingly, the balloon alone, began to put Kaitlin into a contraction pattern. We were using lots of coping techniques to help get her through them. At 7:30pm Kaitlin was having contractions every 3 minutes lasting for one minute. I was hopeful that these were helping her to make change.
Evan had previously told me that he wasn't sure how he would feel during this labor process. He had fear and anxiety from the previous experience, that he hadn't yet processed yet. He did a wonderful job with supporting her. We would take turns helping Kaitlin
At 9:25pm, 8 hours after the balloon had been started, Kaitlin was "maybe 1cm" dilated. Kaitlin was tired, drained, and moaning through the pain. Earlier in the evening we had tried benadryl to help her rest, but she couldn't nap through the intense contractions. She opted for stadol and sleep at this point.
At 1:30am, on July 4th, the balloon was removed and Kaitlin was 4cm dilated and 60% effaced. The balloon had done it's job. I went home to rest and returned to the hospital at 5:30am.
At that time, they had just started pitocin. She was back to having regular contractions. While most women are allowed to eat, when having a balloon placed, the hospital would not allow for Kaitlin to eat or drink anything due to her complications. She was starting pitocin, with her body already at a deficit.
At 9:20am, 8 hours since the last cervical check, Kaitlin was still 4cm and 60% effaced.
Two doctors came in to talk to Kaitlin, both suggesting that while she and baby were doing fine, perhaps consenting to a cesarean would be best after no change. Kaitlin refused. We then started attacking the labor. For the next 5 hours, Kaitlin didn't stop moving. We did every position possible to help apply pressure to her cervix; lunges, hands and knees, in and out of the shower, sitting, rebozo work, etc.
Kaitlin was having extreme back pain with each contraction. I assumed based on what was going on, her baby was "OP", or facing the wrong way in the pelvis.
Another check, 5 hours later, and Kaitlin was still the same, 4cm and 60% effaced. She was so upset. We talked through her options and getting her some sleep. She once again, decided to have stadol. One of things about a narcotic, is that each dose tends to be less and less effective over time. While the first dose helped Kaitlin to get 4 hours of sleep, this last dose only helped her to get 45 minutes of rest or so. Kaitlin was in significant pain, due to babies position.